Stroke patients should receive customized palliative care

The statement is the first in the United States to outline fundamental palliative care for stroke survivors. Palliative care is patient- and family-centered care that improves life by anticipating, preventing and treating suffering.

"The majority of stroke patients need access to some form of palliative medicine," said Robert Holloway, M.D., M.P.H., lead author of the statement and professor and chairman of the neurology department at the University of Rochester in Rochester in New York. "The stroke team and its members can manage many of the palliative care problems themselves. It encourages patient independence and informed choices."

Palliative care should be a collaboration between patients, families, a stroke team and various providers, including neurologists, neurosurgeons, primary care providers, nurses and therapists, he said.

As a stroke survivor or family member, you should expect your healthcare provider to:

• Talk about your preferences, needs and values as a guide to medical decisions.
• Discuss what aspects of recovery are most important to you.
• Have effective, sensitive discussions about your prognosis, how to deal with physical or mental losses from a stroke, and if necessary, of dying, among other serious topics.
• Guide you through choices about life-sustaining treatment options. Providers should address pros and cons of CPR, ventilators, feeding tubes, surgery, do-not-resuscitate orders (DNR), do-not-intubate (DNI) orders and natural feeding.
• Know the best treatment options for common post-stroke symptoms, including pain, other physical symptoms and psychological problems like depression and anxiety.
• Engage a palliative care specialist if complex issues arise.
• Help preserve dignity and maximize comfort throughout the course of a stroke, including during the dying process and when nearing death.

"Stroke is a devastating disease that has received little attention in the area of palliative care so far," Holloway said.

Nearly 800,000 people have strokes annually. About 130,000 stroke-related deaths occur in America yearly. Up to 30 percent of all survivors are permanently disabled.